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Address correspondence to Paul S. Pagel, MD, PhD, Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, 5000 W. National Avenue, Milwaukee, WI 53295.
A 52-YEAR-OLD, 123 kg, 188 cm man, with hypertension, hyperlipidemia, diabetes mellitus,
and coronary artery disease, was referred back to the authors’ institution from the
emergency department of another Veterans Affairs medical center for evaluation of
sharp right chest pain adjacent to his proximal clavicle and superior manubrium of
2 weeks' duration. The patient had undergone uncomplicated coronary artery bypass
graft surgery at the authors’ institution 5 years before the current admission. He
also described right upper extremity tingling and occasional numbness, but he denied
other neurologic complaints. He denied a history of recent trauma and recurrent cardiac
symptoms. The physical examination revealed point tenderness at the inferior aspect
of the right anterior proximal clavicle. No other painful sites were identified. There
were no sensory or motor deficits in the right upper extremity. The median sternotomy
incision was well-healed and the sternum was stable without evidence of dehiscence.
The remainder of the examination was noncontributory. The laboratory analysis was
notable for leukocytosis (white blood cell count = 12.3 K/µL) and mild hyperglycemia
(blood glucose concentration = 165 mg/dL), but no other abnormalities were observed.
A chest radiograph was obtained (Fig 1). What is the diagnosis?
